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Muskuloskeletal Injuries in Mountain Running Races: a 5 Seasons Study
Abstract
Introduction: Mountain running races have grown in popularity in the recent years. Nonetheless, there are few studies on injuries and injury rates. Moreover, these studies have focused on long-distance events such as ultramarathons (>42 km). Therefore, the aim of the present study was to examine the severity, type, and body location of musculoskeletal injuries during 20–42 km mountain running races. In addition, the injury rates in this type of races were examined.
Methods: Data on injuries were collected during 36 mountain running races over 5 consecutive seasons from 2015 to 2019. The participants reported all musculoskeletal injuries on a standardized injury report form. The results were presented as the number of injuries per 1000 h exposure and per 1000 participants.
Results: Twenty eight injuries were reported. Most injuries occurred in the ankle (32%) followed by the knee (14%) and foot/toe (11%). The number of injuries represented an overall injury rate of 1.6 injuries per 1000 h running and 5.9 injuries per 1000 runners. The case fatality rate was 0.
Conclusions: The incidence of musculoskeletal injuries during 20–42 km mountain running races is low. In addition, the majority of injuries experienced by runners are minor in nature and located in lower extremities, mainly the ankles.
... The 16 included studies had a publication date range from 1990 to 2020 and are summarised in Table 1. Injury/illness related to race participation was studied in 13 studies [8,21,22,24,[33][34][35][36][37][38][39][40][41] and four of these studies [22,24,35,41] included data of multiple races. Only three studies [9,42,43] included training-related injury outcomes. ...
... The 16 included studies had a publication date range from 1990 to 2020 and are summarised in Table 1. Injury/illness related to race participation was studied in 13 studies [8,21,22,24,[33][34][35][36][37][38][39][40][41] and four of these studies [22,24,35,41] included data of multiple races. Only three studies [9,42,43] included training-related injury outcomes. ...
... Eleven studies [8,9,21,22,24,[35][36][37][41][42][43] investigated injury-related outcomes and similarly, 11 studies [8,21,22,24,[33][34][35][36][38][39][40] investigated illness-related outcomes. Six of the 16 included studies reported on both injury-and illness-related outcomes [21,22,24,35,36]. ...
Background
Trail running (TR) is characterised by uneven varying running surfaces, with large elevation gains/losses. Therefore, the injury and illness profiles of TR may differ compared to road running. Limited information is available on injury and illness among trail runners (TRs) to help develop interventions towards injury prevention.
Objective
Systematically review data on TR injury and illness.
Design
Systematic review.
Setting
MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed. and Cochrane were searched from inception to February 2019. Methodological quality was assessed using an adapted Downs and Black assessment tool.
Patients (or Participants)
N/A (systematic review abstract).
Interventions (or Assessment of Risk Factors)
Studies were included if they investigated injury and/or illness among TRs participating in training/racing and full-text available in English/French. Studies were excluded on biomarkers of injury/illness in the absence of participants reporting injury/illness, or if no clear evidence was found of investigating TR.
Main Outcome Measurements
TR injury (incidence, prevalence, anatomical site, tissue type, specific diagnosis, severity) and illness (incidence, prevalence, symptoms, specific diagnosis, body system, severity).
Results
Fourteen studies with 3094 participants were included. Six studies investigated injuries and illnesses, 3 studies investigated only injuries and 5 studies only illnesses. Twelve studies investigated race-related injury and/or illness and 2 studies included training-related injuries. Different study designs, injury and illness definitions, race distances, and surfaces, made pooling of results difficult. The foot, knee, ankle and thigh are the most common anatomical sites of TR injury, with lacerations/abrasions, blisters, muscle strains, cramping and ankle sprains most commonly diagnosed. TR illness involved the gastrointestinal tract (GIT), metabolic and cardiovascular body systems. Symptoms of nausea and vomiting related to GIT distress and dehydration are commonly reported.
Conclusions
Injury and illness are common among TRs participating in TR races. Limited evidence is available on training-related injury and illness in TR specific.
... The 16 included studies had a publication date range from 1990 to 2020 and are summarised in Table 1. Injury/illness related to race participation was studied in 13 studies [8,21,22,24,[33][34][35][36][37][38][39][40][41] and four of these studies [22,24,35,41] included data of multiple races. Only three studies [9,42,43] included training-related injury outcomes. ...
... The 16 included studies had a publication date range from 1990 to 2020 and are summarised in Table 1. Injury/illness related to race participation was studied in 13 studies [8,21,22,24,[33][34][35][36][37][38][39][40][41] and four of these studies [22,24,35,41] included data of multiple races. Only three studies [9,42,43] included training-related injury outcomes. ...
... Eleven studies [8,9,21,22,24,[35][36][37][41][42][43] investigated injury-related outcomes and similarly, 11 studies [8,21,22,24,[33][34][35][36][38][39][40] investigated illness-related outcomes. Six of the 16 included studies reported on both injury-and illness-related outcomes [21,22,24,35,36]. ...
Background
Trail running is characterised by large elevation gains/losses and uneven varying running surfaces. Limited information is available on injury and illness among trail runners to help guide injury and illness prevention strategies.Objective
The primary aim of this review was to describe the epidemiology of injury and illness among trail runners.Methods
Eight electronic databases were systematically searched (MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed., and Cochrane) from inception to November 2020. The search was conducted according to the PRISMA statement and the study was registered on PROSPERO international prospective register of systematic reviews (CRD42019135933). Full-text English and French studies that investigated injury and/or illness among trail runners participating in training/racing were included. The main outcome measurements included: trail running injury (incidence, prevalence, anatomical site, tissue type, pathology-type/specific diagnosis, severity), and illness (incidence, prevalence, symptoms, specific diagnosis, organ system, severity). The methodological quality of the included studies was assessed using an adapted Downs and Black assessment tool.ResultsSixteen studies with 8644 participants were included. Thirteen studies investigated race-related injury and/or illness and three studies included training-related injuries. The overall incidence range was 1.6–4285.0 injuries per 1000 h of running and 65.0–6676.6 illnesses per 1000 h of running. The foot was the most common anatomical site of trail running injury followed by the knee, lower leg, thigh, and ankle. Skin lacerations/abrasions were the most common injury diagnoses followed by skin blisters, muscle strains, muscle cramping, and ligament sprains. The most common trail running illnesses reported related to the gastro-intestinal tract (GIT), followed by the metabolic, and cardiovascular systems. Symptoms of nausea and vomiting related to GIT distress and dehydration were commonly reported.Conclusion
Current trail running literature consists mainly of injury and illness outcomes specifically in relation to single-day race participation events. Limited evidence is available on training-related injury and illness in trail running. Our review showed that injury and illness are common among trail runners, but certain studies included in this review only focused on dermatological injuries (e.g. large number of feet blisters) and GIT symptoms. Specific areas for future research were identified that could improve the management of trail running injury and illness.
... The majority of studies included ultramarathons, 6 7 23-25 27 29-32 34 followed by marathons, 11 22 and submarathon distances. 11 Injury outcomes related to 56 different races (submarathon distance: n=34, ultramarathons: n=19 and marathons: n=3) across all six world regions (Europe, 11 23 30-32 34 North America, 25 27 29 Asia, 7 22 24 (table 2). The majority (n=10) of race participation studies used injury definitions related to medical encounters (injuries requiring medical attention during a race) 7 22-25 29 30 32 or clinical assessments (routine assessment of all participants during the study). ...
... The majority of studies included ultramarathons, 6 7 23-25 27 29-32 34 followed by marathons, 11 22 and submarathon distances. 11 Injury outcomes related to 56 different races (submarathon distance: n=34, ultramarathons: n=19 and marathons: n=3) across all six world regions (Europe, 11 23 30-32 34 North America, 25 27 29 Asia, 7 22 24 (table 2). The majority (n=10) of race participation studies used injury definitions related to medical encounters (injuries requiring medical attention during a race) 7 22-25 29 30 32 or clinical assessments (routine assessment of all participants during the study). ...
Objective
To review and frequently update the available evidence on injury risk factors and epidemiology of injury in trail running.
Design
Living systematic review. Updated searches will be done every 6 months for a minimum period of 5 years.
Data sources
Eight electronic databases were searched from inception to 18 March 2021.
Eligibility criteria
Studies that investigated injury risk factors and/or reported the epidemiology of injury in trail running.
Results
Nineteen eligible studies were included, of which 10 studies investigated injury risk factors among 2 785 participants. Significant intrinsic factors associated with injury are: more running experience, level A runner and higher total propensity to sports accident questionnaire (PAD-22) score. Previous history of cramping and postrace biomarkers of muscle damage is associated with cramping. Younger age and low skin phototypes are associated with sunburn. Significant extrinsic factors associated with injury are neglecting warm-up, no specialised running plan, training on asphalt, double training sessions per day and physical labour occupations. A slower race finishing time is associated with cramping, while more than 3 hours of training per day, shade as the primary mode of sun protection and being single are associated with sunburn. An injury incidence range 0.7–61.2 injuries/1000 hours of running and prevalence range 1.3% to 90% were reported. The lower limb was the most reported region of injury, specifically involving blisters of the foot/toe.
Conclusion
Limited studies investigated injury risk factors in trail running. Our review found eight intrinsic and nine extrinsic injury risk factors. This review highlighted areas for future research that may aid in designing injury risk management strategies for safer trail running participation.
PROSPERO registration number
CRD42021240832.
... 3e8 Irrespective of global location, the lower leg (knee through the foot) is the most common region for acute and chronic injuries. 4e7, 9 One study from Greece found that the low back and the knee were the most frequently injured locations, but the most severely injured location was the Achilles tendon. 8 Specific musculoskeletal injuries are patellofemoral pain syndrome, muscle strains (quadriceps femoris, hamstrings, tibialis anterior, calf, back), Achilles tendinopathy, trochanteric bursitis, iliotibial band (ITB) syndrome, ankle inversion injuries, plantar fasciitis, and stress fractures (foot, tibia). ...
This current concept, narrative review provides the latest integrated evidence of the musculoskeletal injuries involved with trail running and therapeutic strategies to prevent injury and promote safe participation. Running activities that comprise any form of off-road running (trail running, orienteering, short-long distance, different terrain, and climate) are relevant to this review. Literature searches were conducted to 1) identify types and mechanisms of acute and chronic/overuse musculoskeletal injuries in trail runners, 2) injury prevention techniques most relevant to running trails, 3) safe methods of participation and rehabilitation timelines in the sport. The majority of acute and chronic trail running-related musculoskeletal injuries in trail running occur in the lower leg, primarily in the knee and ankle. More than 70% are due to overuse, and ankle sprains are the most common acute injury. Key mechanisms underlying injury and injury progression include inadequate neuromotor control-balance-coordination, running through fatigue, and abnormal kinematics on variable terrain. Complete kinetic chain prehabilitation programs consisting of dynamic flexibility, neuromotor strength and balance, and plyometrics exercise can foster stable, controlled movement on trails. Patient education about early musculoskeletal pain symptoms and training adjustment can help prevent injury from progressing to serious overuse injuries. Real-time adjustments to cadence, step length, and knee flexion on the trail may also mitigate impact-related risk for injury. After injury occurs, rehabilitation will involve similar exercise components, but it will also incorporate rest and active rest based on the type of injury. Multicomponent prehabilitation can help prevent musculoskeletal injuries in trail runners through movement control and fatigue resistance.
... A prospective cohort study among Dutch trail runners reported an overall incidence of 10.7 runningrelated injuries (RRIs) per 1000 h, showing a higher incidence of overuse (8.1 per 1000 h) vs. acute (2.7 per 1000 h) RRIs [4]. However, acute injuries, such as ankle sprains, [6] contusions, concussion, [7] and tibiofibular joint and meniscus injury [8], are also reported among both male and female trail runners. ...
Trail running involves running on varying natural terrains, often including large elevation
gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months (p = 0.0032) and having a chronic disease (p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the
knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.
The aim of this study was to analyze the exercise intensity and competition load (PL) based on heart rate (HR) during different mountain running races. Seven mountain runners participated in this study. They competed in vertical (VR), 10-25 km, 25-45 km and >45 km races. The HR response was measured during the races to calculate the exercise intensity and PL according to the HR at which both the ventilatory (VT) and respiratory compensation threshold (RCT) occurred. The exercise intensity below VT and between VT and RCT increased with mountain running race distance. Likewise, the percentage of racing time spent above RCT decreased when race duration increased. However, the time spent above RCT was similar between races (~50 min). The PL was significantly higher (p<.05) during the longest races (145.0±18.4, 288.8±72.5, 467.3±109.9 and 820.8±147.0 AU in VR, 10-25 km, 25-45 km and >45 km, respectively). The ratio of PL to accumulative altitude gain was similar in all races (~0.16 AU·m-1). In conclusion, outcomes from this study demonstrate the high exercise intensities and physiologic loads sustained by runners during different mountain races.
No systematic review has identified the incidence of running-related injuries per 1000 h of running in different types of runners.
The purpose of the present review was to systematically search the literature for the incidence of running-related injuries per 1000 h of running in different types of runners, and to include the data in meta-analyses.
A search of the PubMed, Scopus, SPORTDiscus, PEDro and Web of Science databases was conducted.
Titles, abstracts, and full-text articles were screened by two blinded reviewers to identify prospective cohort studies and randomized controlled trials reporting the incidence of running-related injuries in novice runners, recreational runners, ultra-marathon runners, and track and field athletes.
Data were extracted from all studies and comprised for further analysis. An adapted scale was applied to assess the risk of bias.
After screening 815 abstracts, 13 original articles were included in the main analysis. Running-related injuries per 1000 h of running ranged from a minimum of 2.5 in a study of long-distance track and field athletes to a maximum of 33.0 in a study of novice runners. The meta-analyses revealed a weighted injury incidence of 17.8 (95 % confidence interval [CI] 16.7-19.1) in novice runners and 7.7 (95 % CI 6.9-8.7) in recreational runners.
Heterogeneity in definitions of injury, definition of type of runner, and outcome measures in the included full-text articles challenged comparison across studies.
Novice runners seem to face a significantly greater risk of injury per 1000 h of running than recreational runners.
Background: Nordic pole Walking (NW) as trend sport is asso- ciated with beneficial effects on the cardiovascular system. Data regarding the injury and overload injury rates are pending. Methods: 137 athletes (74 % females, 53 ± 12 years, weight 73 ± 13 kg, height 169 ± 11 cm) were prospectively ask using a two-sided questionnaire. Mean NW experience was 212.8 weeks with 2.9 ± 1.8 hours/week. The overall exposure was 29 160 h. Results: NW injury rate was 0.926/1000 h. Falls were evident in 0.24/1000 h. The upper extremity was involved more frequently (0.549/1000 h) than the lower extremity (0.344/1000 h). The most severe injury was a concomitant shoulder dislocation and luxation of the proximal interphalangeal joint of the index finger after a fall. The most frequent injury in NW was a distorsion of the ulnar collateral ligament of the thumb (0.206/1000 h) after fall. Shoulder injuries account for 0.171/1000 h with 0.069/ 1000 h shoulder dislocations. Distal radius fractures were rare as ankle sprains and shinspints (0.034/1000 h). Muscle injuries were encountered only at the gastrocnemius muscle (0.137/ 1000 h). No knee ligament injuries were noted. In 5 %, NW inju- ries caused interruption of the performance, with all patients re- turning to sport within 4 weeks on the same level as before. Discussion: Nordic Walking is safe. Most frequently, a Nordic walking thumb is encountered during a fall with the athlete holding on to the NW pole until the very last moment before the hand hits the ground with the pole handle as hypomochlium that forces the thumb into abduction and extension. Modifica- tions of the grip construction as well as information of the ath- lete and behaviour changes may be preventive measures. Originalarbeit
To investigate factors associated with menstrual dysfunction, self-reported bone stress injuries and energy balance in women runners.
613 runners were randomly sampled during the registration period for an endurance event. Demographic information, including self-reported height and weight, training and injury history and menstrual history, was collected by questionnaire.
Ultra-marathon (ULTRA) participants (n = 276) were significantly older (mean (SD) 39 (8.2) vs 34 (10.5) years; p<0.001), lighter (58.2 (6.6) vs 59.6 (8.3) kg; p<0.05) and reported a higher training volume (p<0.001) than half-marathon (HALF) participants (n = 337). Significantly more ULTRA subjects than HALF subjects reported a previous bone stress injury (21% vs 14%; p<0.05). There was no difference between the groups for menstrual status, but age at menarche was later (p<0.01) in the ULTRA group. Data were combined according to the absence (REG; n = 368/602 (61%)) or presence (IRREG; n = 234/602 (39%)) of a history of menstrual irregularity. Subject morphology was similar between groups, but the IRREG group had a higher self-reported measure on the self-loathing subscale (SLSS; p<0.01). The whole group was then classified according to current menstrual status, with 165 women being classified as currently irregular. (OLIGO/AMEN; 11.6%) and 445 women as currently regular (EUMEN; 88.4%). There were no morphological differences between the groups, however the OLIGO/AMEN group had a later age of menarche (p<0.01) than the EUMEN group. Further, women who reported a previous bone stress injury had higher SLSS scores than those who did not (2.91 (0.98) vs 2.68 (0.84); p<0.05).
There may be two independent mechanisms associated with energy balance, which are related to bone stress injuries, but may not necessarily be related to menstrual dysfunction.
Competition climbing will debut as an Olympic sport at the 2020 summer games in Tokyo. The aim of this article is to critically review research on the incidence of injury in sport climbing and bouldering. The pathophysiology and clinical presentation of finger and shoulder injuries is discussed. A semisystematic approach in reviewing literature on incidence was applied. Articles were identified after searches of the following electronic databases: Discover, Academic Search Complete (EBSCO), PubMed, Embase, SPORTDiscus, and ScienceDirect. Despite methodological shortcomings of the included studies, we estimated the mean ± SD of the incidence rate of injury in sport climbing and bouldering from the eight studies to be 2.71 ± 4.49/1000 h. Differential diagnosis and the clinical management of finger and shoulder injuries in climbers are challenging. An updated diagnostic and therapeutic algorithm for the clinical management of finger injuries in climbers is presented.
Adequate dietary strategies are essential for the successful participation in ultra-endurance races. The aim of this study was to evaluate and compare the energy and water intakes of participants during three different mountain ultra-endurance runs. The study took place at the “Ultra Mallorca Serra de Tramuntana” (Mallorca, Spain), an ultra-endurance mountain event with runners participating either in a 44-km (Marathon, n = 51), a 67-km (Trail, n = 109) or a 112-km (Ultra, n = 53) run competition. Participants in the study answered a questionnaire focused on the nutritional intake within an hour after finishing the competition. Mean energy intake during the competitions was 183 kcal · h¯1, with an average carbohydrate intake of 31 g · h¯1 (52.1% of participants consumed less than 30 g · h¯1). No significant differences between competitions were found in these parameters. However, a higher percentage of energy from lipids in participants in the Trail and the Ultra was found (P = 0.034). Furthermore, significant differences were observed in water intake per hour of competition (P = 0.039), with the lowest value for the intake during the Ultra competition. In conclusion, the majority of the participants in the study present low carbohydrate intakes. However, fluid intake seems to be adequate. Different distances did not significantly influence the participants’ nutritional strategies.
Methods:
From 1st January 2012 to 31st December 2013 all patients admitted to the Aosta Regional Hospital Emergency Room for any event occurred above 2500 m were screened: all those affected by High Altitude Illness, Acute Illness in High Altitude, Trauma, or Cold disease were prospectively included. Activity incidence rate is expressed as the occurrence of mountain-related events per 1000 hours of mountain activity. Event Incidence rate is expressed as the occurrence of new cases per 1000 hours of mountain activity.
Results:
Two hundred two patients were included during the study period. Trauma (65.1% vs. 24.6%, p < 0.001) and head commotive injury (48.1% vs. 15.1%, p < 0.001) were more frequent during winter compared to the summer season. High altitude illness (36.9% vs. 9.3%, p < 0.001) and cold pathologies (15.1% vs. 0.1%, p < 0.001) occurred more frequently in summer than in winter. Patients (51.4%) were immediately discharged from emergency room, 8.4% after a 24-hour observation period, and 30.6% required hospitalization. During summer, the event risk is 0.013 per person and 1000 hours of mountain activity, while in winter, event risk amounts to 0.005 per person and 1000 hours of mountain activity.
Comments:
High altitude medical events or trauma represent <1% of pathologies observed in the emergency room department of a mountain district in the western Alps. Head commotive injury is the most observed mountain-related event in high altitude, in winter and during ski practice. High altitude illness and cold injuries are observed more frequently in summer, during trekking or climbing activities.
This study aimed to describe injury/illness rates in ultratrail runners competing in a 65-km race to build a foundation for injury prevention and help race organizers to plan medical provision for these events. Prospectively transcribed medical records were analysed for 77 athletes at the end of the race. Number of injuries/illnesses per 1 000 runners and per 1 000-h run, overall injury/illness rate and 90% confidence intervals and rates for major and minor illnesses, musculoskeletal injuries, and skin disorders were analysed. A total of 132 injuries/illnesses were encountered during the race. The overall injuries/illnesses were 1.9 per runner and 13.1 per 1 000-h run. Medical illnesses were the most prominent medical diagnoses encountered (50.3%), followed by musculoskeletal injuries (32.8%), and skin-related disorders (16.9%). Despite the ultra-long nature of the race, the majority of injuries/illnesses were minor in nature. Medical staff and runners should prepare to treat all types of injuries and illnesses, especially the fatigue arising throughout the course of an ultratrail run and injuries to the lower limbs. Future studies should attempt to systematically identify injury locations and mechanisms in order to better direct injury prevention strategies and plan more accurate medical care.
© Georg Thieme Verlag KG Stuttgart · New York.
Objective
To examine the medical care at a highly competitive 161-km mountain ultramarathon.
Methods
Encounter forms from the 2010 through 2013 Western States Endurance Run were analyzed for trends in consultation and use of intravenous fluids.
Results
A total of 63 consultations (8.2% of starters) were documented in 2012 and 2013, of which 10% involved noncompetitors. Most (77%) of the consultations with competitors occurred on the course rather than at the finish line, and were generally during the middle third of the race. Of the on-course consultations, the runner was able to continue the race 55% of the time, and 75% of those who continued after consultation ultimately finished the race. Relative number of consultations did not differ among competitors within 10-year age groups (P = .7) or between men and women (P = .2). Overall, consultations for medical issues were predominant, and nausea and vomiting accounted for the single highest reason for consultation (24%). Although there was an overall decrease in finish line consultations and intravenous fluid use from 2010 through 2013 (P < .0001 for both) that was independent of maximum ambient temperature (P = .3 and P = .4), the proportion of those being treated with intravenous fluids relative to those receiving consultation at the finish line was directly related to maximum ambient temperature (r = .93, P = .037). Both 2012 and 2013 had a single medical emergency that required emergency evacuation.
Conclusions
This work demonstrates that the medical needs in a 161-km ultramarathon are mostly for minor issues. However, occasional serious issues arise that warrant a well-organized medical system.
Purpose:
Ultramarathon running offers a unique possibility to investigate the mechanisms contributing to the limitation of endurance performance. Investigations of locomotor muscle fatigue show that central fatigue is a major contributor to the loss of strength in the lower limbs after an ultramarathon. In addition, respiratory muscle fatigue is known to limit exercise performance, but only limited data are available on changes in respiratory muscle function after ultramarathon running and it is not known whether the observed impairment is caused by peripheral and/or central fatigue.
Methods:
In 22 experienced ultra-trail runners, we assessed respiratory muscle strength, i.e., maximal voluntary inspiratory and expiratory pressures, mouth twitch pressure (n = 16), and voluntary activation (n = 16) using cervical magnetic stimulation, lung function, and maximal voluntary ventilation before and after a 110-km mountain ultramarathon with 5862 m of positive elevation gain.
Results:
Both maximal voluntary inspiratory (-16% ± 13%) and expiratory pressures (-21% ± 14%) were significantly reduced after the race. Fatigue of inspiratory muscles likely resulted from substantial peripheral fatigue (reduction in mouth twitch pressure, -19% ± 15%; P < 0.01), as voluntary activation (-3% ± 6%, P = 0.09) only tended to be decreased, suggesting negligible or only mild levels of central fatigue. Forced vital capacity remained unchanged, whereas forced expiratory volume in 1 s, peak inspiratory and expiratory flow rates, and maximal voluntary ventilation were significantly reduced (P < 0.05).
Conclusions:
Ultraendurance running reduces respiratory muscle strength for inspiratory muscles shown to result from significant peripheral muscle fatigue with only little contribution of central fatigue. This is in contrast to findings in locomotor muscles. Whether this difference between muscle groups results from inherent neuromuscular differences, their specific pattern of loading or other reasons remain to be clarified.
Objective:
To describe injuries and illnesses presented and profile mood states and sleep patterns during a desert environment ultramarathon.
Design:
Prospective study gathering data on mood states and injury patterns.
Setting:
: Gobi Desert, Mongolia.
Participants:
Eleven male competitors (mean mass, 83.7 ± 7.1 kg; body mass index, 24 ± 1.79 kg/m; age, 33 ± 11 years).
Interventions:
Injuries were clinically assessed and recorded each day.
Main outcome measures:
Mood state was assessed using the Brunel Mood Scale.
Results:
All subjects presented with abrasion injuries, dehydration, and heat stress. Vigor decreased over the first 6 days while fatigue increased (P < 0.05). Fatigue and vigor recovered on the final morning. The observed recovery was set against increasing levels of depression, tension, and confusion, which peaked at days 5/6 but returned to day 1 levels on the 7th day morning (P < 0.05). Mean sleep duration (6:17 ± 00:48 hours:minutes; lowest on day 6, 4:43 ± 01:54 hours:minutes) did not vary significantly across the 7 days but did correlate with mood alterations (P < 0.05). Increased anger and fatigue correlated strongly with sleep disruption (r = 0.736 and 0.768, respectively). Vigor and depression displayed a moderately strong correlation to sleep (r = 0.564 and -0.530).
Conclusions:
Injury patterns were similar to those reported in other adventure/ultradistance events. Consistent with previous work, data show increased fatigue and reduced vigor in response to an arduous physical challenge.
Variations in definitions, scores, and methodologies have created differences in the results and conclusions obtained from studies on mountaineering and climbing sports injuries and illnesses; this has made interstudy comparisons difficult or impossible. To develop a common, simple, and sport-specific scoring system to classify injuries and illnesses in mountaineering and climbing studies; such retrospective scoring would facilitate the analysis and surveillance of their frequencies, severity and fatalities, and outcomes of any treatment.
The UIAA (The International Mountaineering and Climbing Federation) makes recommendations, sets policy, and advocates on behalf of the climbing and mountaineering community internationally through its various commissions. Using a nominal group consensus model approach, a working group was formed during the UIAA Medical Commission's meeting in Adršpach - Zdoňov, in the Czech Republic, 2008. This group critically examined climbing and other relevant literature for various methodological approaches in measuring injury incident rates and severity, including data sources, and produced a working document that was later edited and ratified by all members of the UIAA Medical Commission.
Definitions of injury location, injury classification, and fatality risk are proposed. Case fatality, time-related injury risk, and a standardized metric climbing difficulty scale are also defined.
The medical commission of the UIAA recommends the use of the described criteria and scores for future research in mountaineering and climbing sports in order to enable robust and comprehensive interstudy comparisons and epidemiological analysis.
To record the injuries and health problems suffered by ultramarathon runners during a 219-km, 5-day stage race and to help race organizers plan medical provision for these events.
Observational study.
Al Andalus Ultra Trail 2010, in southern Spain.
All 69 ultramarathon runners.
Total numbers and percentages of each clinical encounter with a health professional and their respective health problems.
Sixty-nine competitors started the race, and 39 runners were seen with a medical problem (56.5%). There were a total of 99 clinical encounters. The most common reasons for consulting were foot blisters (33.3%), followed by chafing (9.1%). Lower limb musculoskeletal injuries accounted for 22.2%, predominantly affecting the knee.
This is the first report of a multistage ultramarathon race where medical coverage was present throughout and has reported on musculoskeletal, dermatological, and other medical problems. When providing medical coverage for stage events, the medical team needs to promote practices that minimize injury and address both running-related injuries and non-running-related injuries, taking account of environmental conditions.
This study aimed to describe injury and illness rates in runners competing in 7-d, 250-km off-road ultramarathon events.
Three hundred ninety-six runners competing in the RacingThePlanet© 4 Desert Series ultramarathon races from 2005 to 2006 were prospectively followed. Descriptive analyses were used to evaluate overall injury/illness rates, types of injuries/illnesses, and diagnoses for all medical encounters. Multivariate linear regression was used to estimate the risk of number of injuries/illnesses and 95% confidence intervals associated with age, sex, and race completion time.
Eight-five percent of runners representing a total of 1173 medical encounters required medical care. The overall injury/illness rates were 3.86 per runner and 65 per 1000-h run. Almost 95% were minor in nature, owing to skin-related disorders (74.3%), musculoskeletal injuries (18.2%), and medical illnesses (7.5%). Medical illnesses were more likely on the first day of the race, whereas musculoskeletal and skin injuries were more likely on day 3 or 4. A 10-yr increase in age was associated with 0.5 fewer injuries/illnesses, and females had 0.16 more medical illnesses compared with males.
Despite the extreme nature and harsh environments of multiday ultramarathon races, the majority of injuries or illnesses are minor in nature. Future studies are needed to evaluate additional factors contributing to injuries.
Participation trends in 100 m (161 km) ultramarathon running competitions in North America were examined from race results from 1977 through 2008. A total of 32, 352 finishes accounted for by 9815 unique individuals were identified. The annual number of races and number of finishes increased exponentially over the study period. This growth in number of finishes occurred through a combination of (1) an increase in participation among runners >40 years of age from less than 40% of the finishes prior to the mid-1980s to 65-70% of the finishes since 1996, (2) a growth (p < 0.0001) in participation among women from virtually none in the late 1970s to nearly 20% since 2004, and (3) an increase in the average annual number of races completed by each individual to 1.3. While there has been considerable growth in participation, the 161 km ultramarathon continues to attract a relatively small number of participants compared with running races of shorter distances.
Mountain biking is increasing in popularity worldwide. The injury patterns associated with elite level and competitive mountain biking are known. This study analysed the incidence, spectrum and risk factors for injuries sustained during recreational mountain biking.
The injury rate was 1.54 injuries per 1000 biker exposures. Men were more commonly injured than women, with those aged 30–39 years at highest risk. The commonest types of injury were wounding, skeletal fracture and musculoskeletal soft tissue injury. Joint dislocations occurred more commonly in older mountain bikers. The limbs were more commonly injured than the axial skeleton. The highest hospital admission rates were observed with head, neck and torso injuries. Protective body armour, clip-in pedals and the use of a full-suspension bicycle may confer a protective effect.
Sixty runners belonging to two clubs were followed for 1 year with regard to training and injury. There were 55 injuries in 39 athletes. The injury rate per 1,000 hours of training was 2.5 in long-distance/marathon runners and 5.6 to 5.8 in sprinters and middle-distance runners. There were significant differences in the injury rate in different periods of the 12 month study, the highest rates occurring in spring and summer. In marathon runners there was a significant correlation between the injury rate during any 1 month and the distance covered during the preceding month (r = 0.59). In a retrospective analysis of the cause of injury, a training error alone or in combination with other factors was the most common injury-provoking factor (72%). The injury pattern varied among the three groups of runners: hamstring strain and tendinitis were most common in sprinters, backache and hip problems were most common in middle-distance runners, and foot problems were most common in marathon runners.
To evaluate the injury risk associated with indoor rock climbing competition.
All injuries reported to medical personnel at the 2005 World Championships in Rock Climbing were recorded and analyzed.
Four hundred forty-three climbers (273 men, 170 women) from 55 countries participated in 3 separate disciplines totaling 520 climbing days. Only 4 of 18 acute medical problems that were treated were significant injuries, resulting in an injury rate of 3.1 per 1000 hours.
Indoor rock climbing competition has a low injury risk and a very good safety profile.
To determine if exercise-associated hyponatremia (EAH) was a cause of morbidity among runners requiring medical care at an Australian mountain ultramarathon.
Case series.
Six Foot Track mountain ultramarathon, New South Wales, Australia, March 2006.
Runners presenting to the medical facility.
Serum biochemistry.
No cases of exercise-associated hyponatremia were identified among 9 athletes (from 775 starters) who were treated with intravenous fluid therapy. Unwell runners had a mean serum (Na) of 143 mmol/L (range 138-147 mmol/L). All runners tested had elevated serum urea and creatinine concentrations.
In this setting, EAH was not a significant cause of morbidity.